Disability Specific Services
The austerity period is characterised by
severe cuts to disability services and
supports
During the austerity years we have seen
unprecedented cuts to supports that enable
people to live independently in their
communities. These include the Mobility
Allowance, Motorised Transport Grant,
disability/illness payments, medical cards,
Personal Assistant service, Home Support
service, and the Housing Adaptation Grant.
At the same time, there is a considerable
level of on-going unmet need for services and
supports. In addition, mainstream health
related cutbacks are damaging people’s
ability to live with good health and well-being.
These include high costs of prescriptions
charges, medicines, and hospital charges.
Growing waiting lists for treatments is a
persistent feature of our health system, but
people with disabilities also have a need for
specific treatments relevant to their disability /
illness
People with disabilities have the same
general healthcare needs as everyone else
but in April 2015, 21,821 people remained on
waiting lists for speech and language
assessments and interventions. More than
15,300 people were waiting for assessment
by an occupational therapist, with 2,409
children waiting for over a year. 28,749
people were waiting for a physiotherapy
assessment in April 2015.1 There is also a
growing waiting list for Personal Assistant
services (207) and home help services
(296).2
Austerity has left a crippling legacy not only
on health and social services, but also on
social inclusion and community development
programmes and activities. These services
1
Figures are relevant as of April 2015 and were
provided to Róisín Shortall TD through a Parliamentary
Question (PQ Ref. No. 18511/15).
2 HRB (2014) Table 3.4 Future Requirement for
Personal Assistance and Support Services. These
figures are an under-estimation of the true need of
are vital to people with disabilities since to
live as equal citizens in their communities,
they must be able to engage in community
life as well as availing of mainstream services
and supports.
The budget for disability services has been
reduced by €136 million or 8% since 20083
It is fair to say that the quality of life for many
people with disabilities has not been
enhanced since this government’s election in
2011.
A properly resourced primary and community
care infrastructure is required to provide for
people with disabilities’ needs and to respond
to the growing demand for services. The
cumulative impact of successive austerity
budgets, along with the gross underresourcing of critical health services, has
resulted in increasing delays in treatment,
growing numbers of people on waiting lists,
as well as persistent levels of unmet need.
On an individual basis, disability
organisations have sustained cuts in excess
of these amounts. Fundraised income was
severely affected by the economic downturn.4
This has had a negative impact on both
disability specific and mainstream health
services including essential community-based
services that support people’s health and
participation in their communities.
Voluntary disability organisations play a key
role in supporting linkages and in acting as a
bridge between individuals, their families, and
their health professionals and also between
health professionals in specialist and general
healthcare settings. Furthermore, they
provide a vital link in what is often a
bewildering array of specialist and general
services for a person with a chronic illness or
disability. These organisations also play a
vital part in educating and informing staff
working in primary care and other nonspecialist health services about the needs of
people with specific health conditions.
services due to the voluntary nature of the database,
and because need and future need is self-reported.
3 However, during this time it has seen cuts of up to
16%.
4 Research carried out by DFI in 2012 showed that
over half of the organisations we sampled sustained
an average drop of 17% in their fundraised income.
Timely Access to Quality Disability Services
for all
Restore the budget for disability services to
its former level prior to the recession by
increasing it by €50m each year from 2016 as
an initial measure
Invest in a Community Services and SelfDirected Living Supports approach to make
the current disability services programme ‘fit
for purpose’5
Evidence consistently highlights that better
outcomes can be achieved for people with
disabilities when disability specific services,
and community supports and services are
provided when, where, and how they are
needed.
People with disabilities need to be able to live
in their communities and access a
combination of disability specific and
mainstream health services as required. They
do not require a linear use of disability
services. A Community Services Programme
must be grounded in the principles of person
centeredness, with flexible services that meet
individual needs. It must be designed in such
a way as to give control to the individuals
and/or their families. Synergy is also required
across the range of services under a shared
service model that caters for all people with
disabilities in the community, i.e. people born
with intellectual disability or significant
cognitive impairment, people acquiring a
disability at working age (neurological etc),
and people ageing with a disability.
Meet the unmet need for the Personal
Assistant Service by increasing the budget by
over €7 million each year from 2016 -2019,
and increase Home Support Services by
almost €10m each year
Within the first year of government, undertake
a review on establishing the Personal
Assistance service on a statutory basis
The Personal Assistance Service is the
cornerstone of the Community Services
Programme. The service not only assists with
tasks that the person with a disability cannot
do by themselves, but also supports that
person’s efforts to engage fully in the
community and enables them to live an
independent life.
Legislating for a Personal Assistance service
would provide a right to the service for people
with disabilities who need it, in line with
Article 19 (b) UN Convention on the Rights of
Persons with Disabilities (UNCRPD).
While funding for healthcare is provided for
services at their current levels there is little
evidence of provision for demographic
changes that will see a steady increase of
people with disabilities.7
Access to Disability Services for All: Key
Benefits
 People have more control in accessing
services, and so have a greater
degree of security, and sense of
independence
 People can access services closer to
their location in the community
Key to this is a strengths-based approach to
needs assessment, focusing on supporting
and enhancing ability to enable active
community living.6 Any future commissioning
model of disability services must prioritise the
quality of the service, and its impact on the
person.
5
A Self-directed Supports approach involves a
significant shift for the whole system of health and
social care. Supported people will be given a choice as
to how much control they want to have over their
budget as well as choice over how their support meets
their individual outcomes. This creates opportunities
for new ways of working and providing more innovative
models of support, however, there are challenges in
adapting culture, workforce and systems and
managing this transition.
 People can access seamless services
whether that’s disability specific or in
the mainstream
6
DoH (2012) Future Health
Projections for 2016-2046 show that there will be
1.45 million people aged over 65 in 2046 compared
with 532,000 in 2011: 22% of the population compared
with 12%.
http://www.cso.ie/en/media/csoie/releasespublications/
documents/population/2013/poplabfor2016_2046.pdf
p. 38 Table 1
7